"the rule was to keep patients until their insurance ran out"December 7, 2016 1:40 PMSubscribe

When people called in to ask for help or inquire about services, internal documents and interviews show, UHS tracked what a former hospital administrator called each facility’s “conversion rate”: the percentage of callers who actually came in for psychiatric assessments, then the percentage of those people who became inpatients. “They keep track of our numbers as if we were car salesmen,” said Karen Ellis, a former counselor at Salt Lake Behavioral.

Prisons, Hospitals and Schools: none of these things should be profit-driven.posted by Gwynarra at 2:00 PM on December 7, 2016 [101 favorites]

Top hospital executives could make up to 120% of their annual salary based on their financial performance. Only a modest sum in comparison, an additional 20% of their financial award, could be added based on measures of patient care.

...

But by 9:15 in the morning, his body was in rigor mortis. He had been dead for hours. The autopsy said he died of acute fentanyl toxicity.

Yeah. I'm a person who is extremely deferent to people who are smarter than I and in this case it was the therapist at a PHP program. My undiagnosed OCD had gone into overdrive and I was having ego dystonic obsessive thoughts about harming my wife and the accompanying panic attacks. They sent me in to inpatient for med adjustment with a note of homicidal ideation even though everything was entirely ego dystonic and was causing me quite a bit of distress. I told them I didn't want to go inpatient for this and they said if I didn't that they'd 5150 me.

My wife is still suspicious that it was done entirely for insurance reasons. I don't know what to think. Therapists in institutions hold *enormous* sway over the lives of their patients for better or worse and after this experience it has certainly made me a lot more careful about how I go about treatment of mental illness.posted by Talez at 2:17 PM on December 7, 2016 [18 favorites]

+1000 for Gwynarra. Civilized countries do not generate profit off of the ill, injured, distressed or incarcerated.

Ok that's naive... but you don't abandon the above to the tender mercies of stockholders. Single-payer or something like the French level of control.posted by Artful Codger at 3:15 PM on December 7, 2016 [8 favorites]

In a statement to BuzzFeed News, Paul Sexton, who ran Highlands at the time, said, “I deny any claims that any patients were ever wrongfully held or detained at Highlands. However, patients are not allowed to leave during an assessment for the safety of the patient, the facility, and the community.” Sexton described that as standard practice across all kinds of psychiatric hospitals.

But three leading organizations strongly contradicted that view. “Absent a reason to be concerned about safety, their own or others’, a person who voluntarily presents for an assessment would be free to leave,” said Dr. Steven Hoge, chair of the American Psychiatric Association’s Council on Psychiatry and the Law.

This is horrifying. Like "should be in jail for holding people against their will" level horrifying. People come in for an assessment and they wind up kidnapped even if nobody has determined them to be a danger?posted by zachlipton at 3:50 PM on December 7, 2016 [26 favorites]

This is horrifying. Like "should be in jail for holding people against their will" level horrifying. People come in for an assessment and they wind up kidnapped even if nobody has determined them to be a danger?

Criminal investigations are pending. Too late for at least one...

I guess they're exploiting the definitions of "thought" and "plan". Once that initial "assessment" was done, sounds like no one was even equipped to determine who'd be a danger and who wouldn't be. The billing coders were the best trained people there.

I've had the unfortunate luck of needing inpatient care a few times, and none of this seems off. I learned very quick to not visit general units but to find hospitals specializing in my particular disorders because incompetence runs rampant, understaffing is the norm, and bullshit groups by undertrained staff are the standard of care. The first time I s hospitalized I cannot tell you how many videos of the stigma of bipolar and safety planning for bipolar I watched. I sat through even though 1)I'm diagnosed with PTSD, a disossocative disorder, and an eating disorder. Even in my early 20s I could have led better groups than these folk. 2) I have been told to stop talking about my trauma as it was upsetting other patients.

I've been to phenominal hospitals and have had lengths lengths of stay (I've been hospitalized up to 6 weeks at a time)that I really desperately needed.) I've gotten charity care and insurance has paid or a combo of both. But I've seen patients in equally bad decisions let go in a heartbeat, ive seen people beggingbto be realeased and odd or no justification given.

Uninsured I've had discharge plans of good luck, and insured plans adding PHP, IOP other step down groups .

My hospitalizations that have been effective have all had common things: good ratio of staff, units seperated by diagnosis, 5 day a week psychiatric consulation, and therapy groups run by LCSWs (or other masters or higher level councelors)based on evidenced based approaches, and talk therapy 5 days a week.

I understand with many diagnosis, a simple med adjustment really is everything needed, but that us just not always the case.

Oh and medicare having a lifetime limit if mental health treatment is absolute bullshit.posted by AlexiaSky at 4:41 PM on December 7, 2016 [14 favorites]

Who's a danger to the community? Physician, heal thyself.posted by adept256 at 4:50 PM on December 7, 2016

I thought I'd check on Google News to see if anyone else was picking up on this story, and found this doozy of an article from just yesterday that highlights the bottom-line world of the for-profit treatment industry:

The addiction treatment industry is experiencing a climate of favorable tailwinds, according to Robert Waggener, vice president of addiction services for Universal Health Services, speaking at the 2016 Treatment Center Investment & Valuation Retreat in Scottsdale, Ariz., on Tuesday. And those favorable tailwinds will continue to attract the attention of investors.

...

He recommends that treatment centers gather as many performance metrics as possible before considering a sale. Clean up your accounting, dig into your earnings details and look closely at your expenses, he said. Buyers will ask for a great deal of data before considering a transaction, and the businesses that have data will likely be more attractive than those that don’t.

I used to work at a UHS hospital, and I can verify that a lot of what they say about the staffing is true.

I graduated from nursing school this past spring, knowing that I wanted to do psychiatric nursing. When I saw the post about a job fair at a local psych hospital later in the summer, it seemed ideal. I showed up, got interviews from HR and nursing management on the spot, and got hired early the following week. Maybe the speed of that process should have been a red flag, but I have so much internalized "you spoiled millennial, just take any job you can get" bullshit conditioning that I looked right past the flags.

The next danger sign should have been when I got three days of orientation. In nursing, especially for a new nurse, this is woefully inadequate. A standard orientation period for a new graduate nurse on a regular hospital floor is three months, during which you gradually get more and more responsibilities. My RN friends were all horrified, but I assured them that this was just how it goes in psych, and surely they wouldn't give me more than I could handle.

So, three measly days of training later, and I'm on my own, giving medications on the biggest floor of the hospital. There would be one other RN there, the "charge nurse," doing admissions and paperwork and stuff, but just me giving meds for 36 patients. Do you know how many patients a nurse should have on a regular hospital floor? Five, maybe four on a good day and six in desperate times. 36 patients worth of medication for one person is a ton, and many of the safeguards I'd come to take for granted in regular hospitals that prevent medication errors just weren't there.

On one memorable occasion, another nurse told that I shouldn't have documented an abscess on a patients' foot, because writing it down meant we'd be liable, and our facility wasn't set up to treat non-psychiatric issues well. "She'd want us to treat her every little infection," the nurse said. I refrained from mentioning that that's kind of a medical care team's job.

I bounced a ton from floor to floor. Just as I'd start to build rapport with one set of patients, I'd get to work and find myself assigned somewhere else.

On one of my last days of work, I was the only nurse on a small unit of teenagers. That morning one of my patients had an acute dystonic reaction to one of his medications. This is one of those families of side effects you learn about in school, but you're told it's relatively rare, maybe you won't see it. And here I had a kid with his neck locked up, jaw hanging open such that he could only speak intermittently, telling me "I don't want to go like this." Just typing this out I can hear him again.
He was able to get medication to counter the acute symptoms, and the doc to his credit took him off the symptom-causing meication effective immediately. But for the first while there, before I able to assess the seriousness of the situation, it was just me.

They canned me not too long after that, at the end of my 90 day probation. Said that they liked me personally but that I was too new for this environment, that they didn't want me in a situation where my license would be in danger. Well no shit it's a dangerous situation when you give a new grad three days of orientation and then release them to the wolves. They said it was a new, somewhat risky move on their part to start hiring new grads. Why do it then?

Even though I want to go back to psychiatric care in the long run, I'm applying for general medical positions aimed at newer nurses now, because that is the only way I can see myself really getting my feet under me. It's probably not too wise of me to write this long identifying comment in the middle of a job search, but it was so validating to read this article and see that UHS is fucked up across the board, and it kind of brought out a torrent of feels.posted by ActionPopulated at 5:42 PM on December 7, 2016 [95 favorites]

I had no idea this corporation even existed. Yikes.

I hadn't heard of any of the UHS hospitals in Illinois. But now I know where not to go should I need inpatient psychiatric care.posted by SisterHavana at 5:49 PM on December 7, 2016

If the feds are investigating UHS as a corporate entity and they are found guilty of the charges of false Medicare/Medicaid claims, how would that affect UHS owned hospitals that are not specifically named as being directly investigated? Would it just be a financial impact like "Oops...didn't have as many profits this year!" or would everyone lose their ability to bill Medicare?posted by MultiFaceted at 7:27 PM on December 7, 2016

Now that you've voted in Donald Trump I suppose your Medicare program will be repelled ?
Market driven medical care could be a standard for the western world.
Hospital admin Muppets will be flying in from all over the world to find how this new model works. Sigh.posted by Narrative_Historian at 11:54 PM on December 7, 2016

HMOs get a bad rap, but I have become partial to them for this reason: their incentive is to treat you as little as possible, and get you out. Which may not be ideal, but is a lot better than what goes on in these places.posted by alexei at 12:01 AM on December 8, 2016 [1 favorite]

alexei - the goal of any good physician is to treat you as little as possible. You will get better results when there's a competent health care system behind your physician that's not driven by perverse incentives.posted by Artful Codger at 3:56 AM on December 8, 2016 [4 favorites]

From the medical supplier POV, UHS is also a complete shit-show. So they treat their patients like crap, their staff like crap, and their suppliers like crap. But they make record profits! Their investors must be so proud....posted by sharp pointy objects at 8:23 AM on December 8, 2016 [4 favorites]

Because there isn't enough shitty news for the mentally ill. Good to know that illness are being exacerbated for profit. Also great to hear words like "competitor" and "branding" in the world of social services and health. We need more freemarket bullshit everywhere destroying lives.

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